Early-onset preeclampsia is characterised by an increased vascular tone in internal jugular veins.

Purpose: This study aimed to investigate Doppler characteristics of maternal internal jugular veins in uncomplicated pregnancies vs. those affected by hypertensive disorders. Materials and methods: Venous pulse transit time and venous impedance index were measured at three different locations (right proximal, right distal, left proximal) of internal jugular veins according to a standardised combined Doppler-Electrocardiogram protocol in five different groups of pregnant women: uncomplicated pregnancy, early-onset preeclampsia, late-onset preeclampsia, gestational hypertension, and normotensive pregnancies with a small for gestational age foetus. Values of both parameters of the latter four groups were plotted against the reference range of uncomplicated pregnancies at corresponding gestation. Linear mixed models with random intercept were used to investigate gestational changes in venous pulse transit time and venous impedance index at the three internal jugular vein locations within and between the different groups. Results: A total of 127 women were included: 41 had uncomplicated pregnancies, 13 had early-onset preeclampsia, 25 had late-onset preeclampsia, 22 had gestational hypertension, and 26 had normotensive pregnancies with a small for gestational age foetus. Venous pulse transit time values were lower than uncomplicated pregnancy (p ≤ 0.001) at all three locations in the third trimester of early-onset preeclampsia. Conclusion: Contrary to late-onset preeclampsia and gestational hypertension, early-onset preeclampsia is characterised by a lower venous pulse transit time at internal jugular veins compared to uncomplicated pregnancy, suggesting increased venous vascular tone.

Characteristics of the Maternal Jugular Venous Pulse Waveform by Combined Doppler-Electrocardiogram Assessment.

Standardized combined Doppler-electrocardiogram assessment was performed longitudinally at three different locations of internal jugular veins between 12 wk of gestation and 6 wk postnatally in 24 uncomplicated pregnancies. All images were classified as typical or non-typical based on the presence of the physiologic deflections A, X, H and C. Linear mixed models with random intercepts of typical images were used to investigate gestational changes in venous pulse transit time and venous impedance index. Unequivocal identification of venous pulse transit time and venous impedance index was possible in 2617 of 3798 (69%) and 2234 of 3798 (59%) images, respectively. The best identification rate (80%, 1018/1266) was at the right distal internal jugular vein. Venous pulse transit time increased with gestational age at all locations; venous impedance index decreased at the right sided internal jugular vein. Maternal jugular venous pulse waveform by combined Doppler-electrocardiogram allows unequivocal identification of A-deflection and calculation of venous pulse transit time and venous impedance index in around two-thirds of assessments, with the highest success rate at the right distal internal jugular vein. Gestational evolutions of venous pulse transit time and venous impedance index are similar to those reported at the level of renal interlobar and hepatic veins.

Feasibility of Combined Doppler-ECG Assessment of Internal Jugular Veins.

A standardized combined Doppler-electrocardiography technique was developed for measurement of the triphasic waveform characteristics in the internal jugular vein. Flow velocities at the A, X, V and Y peaks, the RR interval and the PA and RX times were measured. From these the venous impedance index ([X-A]/X) and the ratios PA/RR and RX/RR were calculated. Six measurements were performed at three different locations by two ultrasonographers in 21 randomly selected pregnant and non-pregnant women. Statistical models proved the feasibility and reproducibility of this technique, with the highest concordance correlation coefficients in the right distal internal vein. Bootstrapping revealed that repeating the measurements more than four times would not significantly enhance the precision of the estimated mean. Concordance correlation coefficients for the venous impedance index, PA time and PA/RR ratio were >0.63 for all three locations, proving their possible use in ongoing and future studies, analogous to previous studies in kidney and liver.

Case report: incarceration of the gravid uterus: a radiologic and obstetric challenge.

We will present the fourth case in the English-language literature of a mid-gestational colonoscopy-assisted manual reposition of an incarcerated uterus. Despite the ready availability of ultrasound, a great number of incarcerations are not recognized before term. Since early diagnosis is the key to a successful treatment, it is important that providers acquire prompt knowledge of this obstetric disorder. Magnetic Resonance Imaging has an important additional value to ultrasound in the detailed scanning of this potentially perilous condition.

Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging.

Incarceration of the gravid uterus is a rare obstetric disorder that is often not recognized despite the ready availability of ultrasound. However, detailed imaging of the disturbed uterine and pelvic anatomy - from an obstetric point of view- is the key in reducing the potentially severe complications of this condition and planning its treatment. In this paper, we will describe the specific magnetic resonance imaging (MRI) features of an incarceration of the gravid uterus and we will discuss the role of magnetic resonance imaging in defining anatomy and in the medical decision whether to operate or not.

Recurrent incarceration and/or sacculation of the gravid uterus: a review.

Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only one case report of incarceration of an anteflexed gravid uterus and six reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.

Aggressive angiomyxoma of the vulva: a case report and review of literature.

BACKGROUND: Aggressive angiomyxoma (AA) is a rare vulvovaginal mesenchymal neoplasm with a marked tendency to local recurrence but which usually does not metastasize. CASE REPORT: We describe a case of AA in the left labium majus pudendi in a 47-year-old woman who underwent incomplete surgical excision. Follow-up 2years later revealed no recurrence. CONCLUSION: In the past, most authors advocated wide excision even if genitourinary and digestive tract resection were necessary. These days, a less radical surgery is recommended, but the significance of hormonal treatment and/or radiation therapy is not clear yet. Further investigation is necessary.